Benign Laryngeal Neoplasms

Recurrent Respiratory Papillomatosis

• second most common cause of hoarseness in children

• 2/3 present before age 15, usually regresses by puberty

• extremely rare malignant change (higher risk in adults and HPV types 16 and 18)

• Pathophysiology: HPV type 6 and 11 (similar to genital warts) ^ abnormal growth

• Risks: younger, first-time mothers (longer second stage of delivery in the birth canal), lower socioeconomic status; 50% born from mothers with maternal condyloma acuminata, oral sex, multiple sexual partners

• Lesion: wart-like, irregular, exophytic (cluster of grapes), between any junction of ciliated and squamous epithelium (limen vestibuli, midzone epiglottis, ventricle margin, and undersurface of true vocal fold), nasopharyngeal, tracheal, and bronchial lesions are usually from contamination

1. Juvenile: children, multiple sites of involvement, recurrent, may resolve spontaneously

2. Senile: may involve single sites, recurrence less common, identical histology

• SSx: first presents with hoarseness then inspiratory or biphasic stridor, dyspnea, dysphagia

• Dx: flexible nasopharyngoscopy, videostroboscopy, endoscopy with biopsy

• Complications: pulmonary involvement (rare), may cause hemorrhage and abscess formation, respiratory compromise

Management

• Microlaryngoscopy with Laser Excision: frequent conservative endoscopic CO2 laser ablation (biopsy to evaluate for malignancy)

• avoid tracheotomy, may seed lower airway or stoma

• Postoperative Management: yearly chest x-rays to evaluate pulmonary involvement, close follow-up with interval endoscopies (2-4 weeks after initial treatment)

• Adjunctive Therapy: (controversial) aINF (induces an antiviral and antiproliferative effect), acyclovir, Indole-3-carbinol

Chondromas

• Pathophysiology: most commonly arise from internal posterior cricoid cartilage (hyaline cartilage), may also arise from thyroid, arytenoid, epiglottic cartilage (fibroelastic)

• SSx: insidious hoarseness from vocal fold restriction, dyspnea for subglottic lesions, dysphagia for posterior cricoid lesions, globus sensation

• Lesion: smooth, firm, fixed tumor, normal mucosa

• Dx: endoscopic wedge biopsy, CT of neck (calcification)

• Rx: complete excision via an endoscopic or external approach (depending on the size of lesion)

Granular Cell Tumor

• 3% risk of malignant degeneration

• Pathophysiology: arise from Schwann cells in the posterior aspect of true vocal fold or arytenoids (originally believed to arise from myoblasts), may also be found on tongue, skin, breast, and subcutaneous tissue

• SSx: insidious hoarseness

• Lesion: small, sessile, gray mass

• Dx: endoscopy with biopsy

• Histopathology: may induce pseudoepitheliomatous hyperplasia near epithelial borders (often confused with SSC), polygonal uniform cells with vesicular nucleus, coarsely cytoplasmic eosinophilic granules, PAS and S-100 positive

• Rx; complete excision via an endoscopic or external approach (depending on the size of lesion)

Lymphangiomas (Cystic Hygromas)

• 90% present before 3 years old (65% present at birth), may persist in adult

• associated with venous malformations (lymphatics and venous system develop concurrently)

• SSx: soft solitary painless compressible mass (lymphatic dilation), dysphagia, dyspnea, may remain dormant

• Dx: clinical exam, endoscopy and biopsy

• Histopathology: lymphendothelial hyperplasia, during proliferative phase there is an increase in mast cells, during the involutional stage there are few mast cells

• Complications: respiratory distress, infection, disfigurement

• Rx: early conservative excision when symptomatic (spare vital structures), low rate of recurrence if completely removed (only 50% if gross tumor remains)

Hemangioma

• most common head and neck neoplasm in children

• typically presents by 6 months old then involutes by 2 years of age

• most common laryngeal site left posterior lateral quadrant of subglottis (although may appear anywhere in upper respiratory tract)

• 50% of subglottic hemangiomas associated with cutaneous involvement

• Pathophysiology: abnormal blood vessel growth

• Types: Infantile (typically subglottic), Adult Onset, Compact or Capillary (more common in infantile type, typically resolves), Cavernous (may enlarge rapidly, less chance of regression)

• SSx: polypoid or sessile lesions (left > right), biphasic stridor, worse with crying (hemangiomas become engorged with blood), dysphonia, dysphagia, seldom causes bleeding in the larynx

Management

• may observe if asymptomatic and nonprogressive

• embolization

• corticosteroids or interferon a-2A

• endoscopic CO2 or argon laser excision (YAG lasers, although used for vascular tumors, do not work well with hemangiomas) or open excision for large lesions

• radiation therapy may be considered although increases risk of malignant degeneration

0 0

Post a comment